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By: James M. Deren

Patients who are adherent in taking their prescription medications spend significantly less money on total healthcare costs than their counterparts. In fact, adherence to drug therapies reduces increased pharmacy costs by 13 to 1 (CVS Caremark, 2011). Below are some examples of several Per Member Per Year (PMPY) savings categories (Reuters & CVS Caremark, 2011): 

Savings  Chronic Condition 
$7,823 –  Congestive Heart Failure
$3,908 –  Hypertension

$3,756 –  Diabetes

$1,258 –  Dyslipidemia

Finding ways to help increase drug therapy adherence through proper plan design is extremely important. It lowers medical costs, increases overall job performance, and job productivity. Therefore, making it easy for plan members to access their maintenance prescriptions such as heart medication, high blood pressure, and diabetes—saves money on over all healthcare costs. 

Plan members normally fill maintenance prescription drugs 30 days at a time. The cost basis for these drugs through the health plan is known as “Average Wholesale Price” (AWP). Most of the 30-day supply medications’ drug costs are approximately AWP -19 to -22 percent (19 to 22 percent below wholesale price) depending on how the Pharmacy Benefit Manager (PBM) contract is structured. However, a health plan can purchase a 90-day supply of the same generic medications at an AWP of -40 to -70 percent.

That is, a health plan can save about 30 to 80 percent of its prescription drug cost by simply structuring the pharmacy program for the plan members to purchase their generic medications on a 90-day at a time rather than a 30-day brand supply.

In order for employers to yield savings on drug costs, the contractual ingredients must exist between the employer’s health plan and the PBM. PBM’s pay fewer rebates on mail order prescriptions than on retail prescriptions, which means employers can spend less on the mail order “type” prescriptions if the proper incentives exist for plan members. Insurance companies rely on plan members filling their prescriptions on a 30-day supply to generate healthy rebates for the insurance companies.

Group Benefit Services (GBS) has an arrangement and the contractual ingredients with our PBM’s that allows plan members to access a 90-day supply of maintenance drugs directly from a pharmacy in lieu of the mail order program, while employers yield similar savings mentioned herein for the 90-day supply.

Proper plan design will not only save the plan and its members money by purchasing the maintenance drugs in this manner but also make it easier for the plan members to be adherent to their drug therapies as well as saving the employer money on its overall healthcare dollars.

At GBS, we “partner” with employers to develop health plans and strategies that meet their specific goals. We also educate our clients’ plan members on how to access the programs that will save them money and enhance their health and wellness.

It would be an honor to have the opportunity to provide a detailed proposal and show you how these programs can assist your members and save your health plan money.

Posted 12:10 PM

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